Cardiac Flashcards
1
Q
questions to ask ANY cardiac patient
A
- what TYPE of cardiac disease?
- who is managing cardiac disease?
- any hx of cardiac surgery?
- any special positioning precautions?
- any dental pain right now?
- current list of heart medications?
2
Q
what is the #1 birth defect?
A
congenital heart defects (CHD)
3
Q
what percent of births per year in the US have CHD?
A
1% - or ~40,000
4
Q
T/F: the prevalence of some CHDs, especially mild types, is increasing, while the prevalence of other types has remained stable
A
true
5
Q
what is the most common type of heart defect?
A
ventricular septal
6
Q
what percent of babies with a CHD are critical?
A
~25%
7
Q
T/F: infants with critical CHDs generally need surgery or other procedures in their first year of life
A
true
8
Q
what percent of babies born with a non-critical CHD are expected to survive to one year of age?
A
~97%
9
Q
what percent of babies born with a non-critical CHD are expected to survive to 18 years of age?
A
~95%
10
Q
what are the most common types of CHDs?
A
- ASD
- VSD
- atrioventricular septal defect
- coarctation of the aorta
- hypoplastic left heart syndrome
- pulmonary atresia
- tetralogy of fallot
- total anomalous pulmonary venous return
- tricuspid atresia
- d-transposition of the great arteries
- truncus arteriosus
11
Q
what is CHDs often associated with?
A
- Down syndrome
- inborn errors of metabolism (i.e. homocystinuria)
- CT disorders (i.e. osteogenesis imperfecta)
12
Q
T/F: most CHD problems are minor or self limited
A
true
13
Q
what percent of infants born with a CHD will have a critical condition (will need surgery or other procedures during their 1st yr of life?
A
~25%
14
Q
between 1986-1996, mortality was reduced by what percent?
A
18% thus population of people with CHDs is growing
15
Q
normal cardiac fxn
A
- oxygen poor blood –> 2. right atrium –> 3. tricuspid valve –> 4. right ventricle –> 5. pulmonary artery –> 6. lungs –> 7. left atrium –> 8. mitral valve –> 9. left ventricle –> 10. aorta
16
Q
atrial septal defect (ASD)
A
abnormal opening between the right and left atria
17
Q
what happens with ASD?
A
blood of right and left atrium mix
18
Q
T/F: 2:1 male to female ratio for ASD
A
false, 1 male : 2 female
19
Q
T/F: ASD is symptomatic
A
false, asymptomatic
20
Q
what may happen if the ASD is large?
A
- pulmonary hypertension
- right side heart enlargement
- cardiac heart failure
- atrial arrhythmias
- stroke
21
Q
what are the different types of ASD?
A
- secundum
- sinus venosus type
- ostium premium
- coronary sinus atrial septal defect
22
Q
what percent of all ASD cases are secundum type?
A
80%
23
Q
secundum ASD
A
failure of the atrial septum to close during development
24
Q
sinus venosus ASD type
A
drainage of right pulmonary vein into right atrium instead of left
25
ostium premium ASD
clefting of mitral valve (family of atrio-ventricular canal defect)
26
which ASD type is commonly associated with Down syndrome?
ostium premium ASD
27
what percent of individuals with Down syndrome have AV septal defect?
~65%
28
where is the coronary sinus atrial septal defect?
within coronary sinus
29
T/F: coronary sinus atrial septal defect is the more common type of ASD
false, more RARE
30
ventricular septal defect (VSD)
abnormal opening between the ventricles
31
T/F: VSD usually occur by themselves, without other birth defects
true
32
what percent of all CHDs are VSD?
~30%, about 1 in 500 new births
33
T/F: VSD is slightly more common in males
false, females
34
the clinical significance of VSD is directly reflected to what?
the size of the defect
35
VSD is similar to what?
having one ventricle ("Fontan Circulation")
36
what are the different types of VSD?
1. membranous
2. muscular
3. atrioventricular canal type VSD
37
what is the most common type of VSD?
membranous
38
T/F: surgery is often needed with membranous VSD
true
39
what is common with singular muscular type of VSD?
spontaneous closure
40
how is multiple muscular VSD described?
"Swiss cheese"
41
T/F: multiple muscular VSD requires very complex surgical management
true
42
where is the atrioventricular canal type VSD?
near tricuspid
43
what is needed to fix atrioventricular canal type VSD?
surgery needed
44
patent ductus ateriosus
failure of ductus arteriosus to close after birth
45
what does patent ductus ateriosus lead to?
leads to blood travelling from aorta to pulmonary artery
46
the blood in patent ductus ateriosus is initially what and leads to what if not tx'd?
acyanotic (left to right) to cyanotic (right to left)
47
T/F: patent ductus ateriosus has 2:1 female to male
true
48
patent ductus ateriosus affects how many premature births?
8:1000
49
patent ductus ateriosus affects how many term births?
2:1000
50
what causes tetralogy of fallot?
an abnormal location of the muscle that separates the aortic valve and the pulmonary valve
51
what is the male:female ratio for tetralogy of Fallot?
3 male:2 female
52
what is the most common cyanotic defect after 1 year old?
tetralogy of Fallot
53
what is often present at birth with tetralogy of Fallot?
patent ductus arteriosus
54
tetralogy of Fallot
1. VSD: less oxygenated blood to body
2. pulmonary stenosis: less blood to lungs
3. (R) ventricular hypertrophy: increased work
4. transposition of the aorta: less oxygenated blood to body
55
what complications do children with tetralogy of Fallot often have?
1. pacemakers sometimes required
2. post-surgical arrhythmias (bradycardia)
3. residual post-surgical defect
4. fatigue/cyanosis
56
coarctation of the aorta
narrowing of aorta
57
what does coarctation of the aorta cause?
1. upper body HTN
| 2. lower body hypotension
58
what is coarctation of the aorta often accompanied by?
aortic valve defects
59
where is coarctation of the aorta?
where ductus arteriosus closes
60
indications for pediatric heart transplantation
1. life expectancy <1 year
| 2. significant limitations on daily life
61
causes of end-stage heart disease in children
1. viral or idiopathic cardiomyopathy
| 2. severe congenital heart defects
62
how many pediatric heart transplants are performed per year?
~500
63
T/F: it is difficult to obtain donors for pediatric heart transplants
true
64
T/F: pediatric heart transplants are a palliative measure, not curative
true
65
what improved the survival rate after pediatric heart transplant?
1. advancements in PICU
2. immunosuppression is more effective
3. statins to reduce coronary disease
66
what is the first choice of immunosuppressive drug for pediatric heart transplant?
Tacrolimus
67
why is Tacrolimus the first choice immunosuppressive drug for pediatric heart transplant?
no gingival overgrowth
68
which immunosuppressive drug for pediatric heart transplant is used less now?
steroids
69
survival of pediatric heart transplant is approximately what percent at 3 years?
90%
70
who needs SBE prophylaxis?
1. prosthetic cardiac valves, including transcatheter-implanted prostheses and homografts
2. prosthetic material used for cardiac valve repair, such as annuloplasty rings and chords
3. hx of infective endocarditis
4. cardiac transplant with valve regurgitation due to structurally abnormal valve
71
which congenital heart diseases require SBE prophylaxis?
1. unrepaired cyanotic congenital heart disease including palliative shunts and conduits
2. any repaired congenital heart defect with residual shunts or valvular regurgitation at the site of or adjacent to the site of a prosthetic patch or a prosthetic device
72
infective endocarditis is more common in what type of patients?
heart transplant recipients than in the general population
73
when is the risk of infective endocarditis the highest?
the first 6 months after transplant
74
why is the risk of infective endocarditis the highest in the first 6 months after transplant?
because of
1. endothelial disruption
2. high-intensity immunosuppressive therapy
3. frequent central venous catheter access
4. frequent endomyocardial biopsies
75
pediatric patients that need SBE prophylaxis
1. cyanotic CHD that has not been fully repaired, including children who have had surgical shunts and conduits
2. CHD that's been completely repaired with prosthetic material or a device for the first 6 months after the repair procedure
3. repaired CHD with residual defects, such as persisting leaks or abnormal flow at or adjacent to a prosthetic patch or prosthetic device
76
cyanotic CHD
birth defects with oxygen levels lower than normal
77
prophylaxis is recommended for the patients identified in the previous section for all dental procedures that involve what?
manipulation of gingival tissue or the periapical region of the teeth, or perforation of the oral mucosa
78
dental care for cardiac patients pre-surgery and pre-transplant
1. review med hx
2. consult with cardiologist
3. review dental hx
79
goal of dental care for cardiac patients
eliminate all existing or potential sources of infection and trauma in the oral cavity
80
what can be done if it's not possible to complete all dental tx for cardiac pts?
temporary restorations can be placed and non-acute dental tx can be delayed until pt is stable
81
T/F: complete a detailed clinical and radiographic exam as early as possible and determine an aggressive prevention and dental plan
true
82
what should be considered when completing a dental tx?
1. pt's behavior
2. ability to tolerate tx
3. amt of dental needs
4. interest in dental health
5. urgency of tx completion
6. need for IE prophylaxis
7. risk/benefit of maintaining each tooth
8. risk of infection or bleeding post-op
83
other dental considerations for pediatric heart transplant pts
1. respiratory depressant such as opioids, barbiturates and other sedatives can worsen the cardiovascular status
2. atropine and similar agents produce tachycardia
3. N2O-O2 can be used safely
4. small amt of epi used in LA is not likely to cause serious cardiovascular compromise
84
when would a small amt of epi used in LA will likely cause serious cardiovascular compromise?
restricted outflow track defects
1. aortic stenosis
2. hypertrophic cardiomyopathy
85
high cariogenic potential of pediatric meds (digoxin, abx, antifungal rinses, etc.) and dietary supplements (i.e. Pediasure) are due to what?
lack of growth
86
long-term sequelae of cyclosporine
1. gingival overgrowth (roughly 30-50% pts)
| 2. cancers (rates ~50%) - skin and oral cancers
87
medication to tx high BP due to cyclosporine use post-surgery/transplant
Nifedipine
88
what may Nifedipine cause?
gingival hyperplasia
89
anticoagulant therapy to use post-surgery/transplant
coumadin and aspirin
90
what should be avoided post-surgery/transplant?
avoid NSAIDS, use acetaminophen
91
why should NSAIDS be avoided post-surgery/transplant?
1. increase risk of bleeding
| 2. can exacerbate heart failure
92
most appropriate INR level of anticoagulation for dental extractions
1.5-2.5
93
therapeutic range INR
2-4
94
high INR
5 or greater
95
what does a high INR indicate?
high chance of bleeding
96
low INR
~.5
97
what does a low INR indicate?
high chance of clotting
98
normal INR
0.9-1.3
